Orthopedic appliance and method of making the same



Feb. 17, 1948. DIAMOND ET AL 2,436,164

ORTHOPEDIC APPLIANCE AND METHOD OF MAKING THE SAME Filed D ec. 24, 1943 5 Sheets-Sheet 1.

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ORTHOPEDIC APPLIANCE AND METHOD OF MAKING THE SAME Filed Dec. 24, 1943 s Sheets-Sheet 2 Lou/5 3/4/70? 7 woman: 3. Vazm;

Feb. 17, 1948. DIAMOND ETAL 2,436,164

ORTHOFEDIC APPLIANCE AND METHOD OF MAKING THE SAME Filed Dec. 24, 1943 5 Sheets-Sheet 3 Patented Feb. 17,

fi-"znsefiiig I ORTHOPEDIOARRLIANGEANDJMETHODROF,

MAKING mm SAME 'Ap iliodtion 'Deceniber I "'3Clai1ns.

I I II The invention i elates to corrective roomppheinces fend especially toftho'se :idapted 'tprestore 'inial'functions-and thejinetho'd of'making'the .7 a I t ronajtmn, abdution, aversion and 'weakness of t-he fofotye niereipalliative device is objectionable 1ack$ therapeutic va'lueand'only a; de-

capable a: restoring structural alignment icil niiist 'be 'c'ons'idered,-"a'nd fiindamentallyth position and function of the calcaneiiin (oecalis) ana-its 'relatio'nto the Skeletal sie'g'me'nts (if the foot is'afphme mportance; I

Y *Any 'rotationo' Fthe caleaneom winflalt'erwhe elaitive angulation" of the articulations aln'd the j ge erhl I oseo'us alignment of the root proper. "-This 'basic --fact -is' frequently overlooked in fview of the more manifesteindbomblidited mala lignmien-ts apparent i 'upon examination and' cons e- 'uentIy-Inore *attentio'n has-been paid 'toreti f g iiagsymptomsinetead of causes. I

In the -evbllition' development of men, the

limntal changes" that were taking place I "fI- mpathological conditions 'offtl'iefoot such as;

v and promotingthenormail function'of thefciOt 24:i543}Smother-5155510 I i I I v nes "of the} foot enter to its locomotive, stab" m ahdfp opulsive' action.

. Weight fi' rSt fails CQPY first metatarsal is forced away from its fulcrum into a position of abduction, causing the foot to pronate. The burden of leverage must then be assumed by the second and third metatarsals, thus creating an unnatural weight-stress and fulcrum point at the head of the second metatarsal bone. X-ray examination in pronated feet with metatarsal contractions show this distinctly. I

In providing normal stabilization for the foot it is necessary that the outer segment be maintained in alignment and the heel held from rotating outward and upward. If. this. outer be more easily strengthened and normal weight-, bearing will result. '1

It is, therefore. repeated that it is due to the distortion of the calcaneum and the outer seg-- ment, that a collapse of the inner segmentdee velops, with subsequently more pressure on the head of the second metatarsal.

It is reasonable to assume, that the inner segment which is superimposed upon the outer'segment when it is collapsed, will produce a greater amount of weight-stress bearing, at the first,

- second, and third metatarsal heads.

The first metatarsal, being unable to act as a lever and stabilizing factor in the pronating and collapsing foot due to mechanical and physical restrictions, throws an added weight-bearing function on the second metatarsal head. This produces general shifting of weight-bearing on the inner segment of the foot with an enlarged and traumatized second metatarsal head.

In modern footwear where the shoe is a factor in maintaining the alignment of the foot, the here and the general construction very often defeat the best intentions of orthopedic skill.

\ Shoes and their relation to foothealth must be considered; This particularly is true in respect to the flare of the shoe which should coincide with the fiareof the foot.

d To overcome the deficiency in modern shoe construction, which is very often the factor in producing a foot abnormality, a principle 'of flare determinationhas been devised which pro- 'vides a scientific determination across the'five metatarsal heads'of an axis which is'the hinging structure of the foot in locomotion [and at which point the normal hinging of the shoe should also occur if it is to correspond synehronously to the natural hinging of the foot at this point. g

The principle of determining the normal flare of the normal foot is very simple and can be ascertained from the position of the metatarsal "heads. The position or the angle of transverse axis at this point establishesthe correct flare'of the foot. The combined action of the metatarsal heads at this transverse axis creates a unified, synchronous jointactione If the shod foot is to remain in normal balance, the shoe must co-ordinate with this function of the foot at the metatarsal phalangeal transverse axis.

To determine the normal flare of the abnormal foot it is necessary to measure the amount of contraction of the metatarsal bones and the amount of elevation of the'phalanges above their normal longitudinal alignment with the metatarsal bones. d

In a normal foot the phalanges form a con-' tinuation or extension of the metatarsal bone.

' If the phalanges are out .of longitudinal alignment with the metatarsal bones then the bending axis is e ii -Pa er re ien e t in x 7" 7 from -20 to 30 degrees. structure is maintained the inner segment will:

across the metatarsal heads and the elevation of the phalanges and the depression of the metatarsal bones cause a shifting of the hinge axis and are indicative of the degree of displacement of the hinge axis resulting in abnormal foot binding at this point. The extent of the elevation determines the distance between the abnormal axis and thenormal axis shifted anteriorly.

In modern shoe construction, nearly all shoes are made on an in-fiare last. We therefore find,

- that the shoes worn by most people break across the metatarsal heads on a transverse angle of The fact of most humans, however, are found by our typing method to be at a much straighter transverse angle. By ,e this failure of the foot and shoe to properly coinoide, a contraction of the dorsal ligaments and tendons is produced, depressing and rotating the fourthand fifth metatarsals, thereby upsetting the stabilization of the entire outer segment of r the foot.

. The foundation stabilizer. has been created and successfullyemployedlto correct this deficiency. To properly determine the flare of the foot, it is necessary t draw a straight line from the great to'eljoint across to the metatarsal phalangeal joint of the fifth toe. If the line is at an extreme angle from the centerof the articulation of the great toe 'joint, as much as thirty degrees, then the foot would be classified as infiare. If it is at a lesser angle, the foot would then be typed as a straight flare. In'instances where the fifth toe joint is almost directly opposite to, or even a degree or more ahead of the first metatarsophalangeal articulation the foot maybe considered an outflare foot. v l

v It is, therefore, an object of the invention to provide a foundation stabilizer capable of reestablishing the normal foundation for the bones of the foot, to shift the displaced bending axis while standing and walking.

It is a further object to provide a corrective device which is molded to the contour of the foot,

providing a cupped heel seat for the calcaneum to maintain itin its correctposltion.

A further object aims at providing a corrective device molded to the contour of the foot in its relaxed state when the contour of the plantar surface of the foot is at the highest normal point of elevation since no weight and muscular weakness manifest themselves in this condition.

Another object-is to provide a stabilizer for the foot adapted to be placed in the shoe, and to create a corrective influence on the foot compelling the foot'to function normally regardless of proper construction of the shoe, the only requirement bjelng that the shoe be long enough and wide enough forcomfortable shedding.

A still further object is a novel method of producing an orthopedic corrective device.

Another object aims at providing a corrective device which extends from the heel up to and under the web of the toes.

It isstill another object to provide a corrective device which has a semi-flexible front extensior beyond the metatarsal heads to hold the outel segment in position as the foot is dorsiflexed during the propulsive action in walking, when thl heel is elevated and weight is transmitted to thr front part of thefoot.

1 A still further object constitutes the provisioi 0f a corrective device which is laminated-tn 'laminations being determined by the pathologi iof the invention :part thereof, and illustrat eiimtin'd *iview'wlriich' will ibecome aipparent from-a -perusaI the latter comprises :Lthef novel-T:

- isteps of aimethodiand-ithe means for carrying it flout. as described "in the 'zfollowing specification,

I iparticularly 'pointed-outiin the :claims :forming a ed in .the accompany drawinga-r in which: :Figs. :1 toB are'plan-viewsof the skeletal struc 'ture ofthe foot-and its hingeaxis. I

'1 Figs. 4 tot are-bottom plan views. of theni'odel and :disclosing various stages iof construction .of

S. iwith'ithe invention. I v wiFig's. "7 Bare .lbott-om plan views of the {model showing ifurther stages-in ithe construction iof the-device. 1 q r Fig. 9 is a bottom plan view :of the-device. Fig. '10 is :a side view of the device. Fig. 11. is .alongitudinal section through a slight modification, and V Fig. 12 shows in elevat'iona-l view the device -applied to a shoe and. to disclose the interior. H In constructing the orthopedic device the hinge axis of the device-is first "determined. From clinical examinations of strh-ousands of feet," ;it:lias

i lhe'enestab'lished that theangle of the'foot-at the":

:mietatarsal heads varies from -.=The.ang1e is determined :by drawing a straight five to thirty dethe fifth toe.

The line AB in Fig; Us at an extreme angle, such as thirty degrees 'fromthe joint axis of the straight foot as shown 3 and'is termed 1 9.11 -"lnflare. r v e lesser angle ofthe iine l c -D in Fig. 2 is termed an outfiare, while the line E-F in Fig. 3 is termed a straight.

The bend of the foot along any of the three lines shown in Figs. 1 to 3 determines the hinge axis of the device which is made up of a pattern not controlled by the dimension of the shoe but by the contour of the foot and is somewhat larger as will be hereinafter further explained.

In constructing the device a slipper cast is made from the relaxed foot and a positive model M is made from the negative slipper impression.

Thereafter a transverse line is drawn on the model M connecting thejcenters of the articulation of the first and fifth metatarsal phalangeal joints which line has the angularity of any of the lines shown in Figs. 1 and 3.

Thereafter a basic pattern is cut (shown in Fig. 6) which extends from the heel of the foot to and under the web of the toes and of sufficient size to be molded or shaped to the contour of the foot when in relaxed state and forming a cup seat for the heel.

The basic pattern is made of fabricated cellulose acetate or other suitable material and is softened such as in butyl acetate before being applied to the model to extend anteriorly to the web of the toes and posteriorly encasing the. plantar surface of the heel.

Then a line I 6 preferably with an indelible penoil is drawn which coincides with the line H of the model.

The line It is the guide line, for the further construction of the device.

Thereafter laminations or reinforcements are 1 mez f'rom the great toe ,joint to (Figs. 1,=,tos a) isacros's to the metatarsal phalangeal joint ll of:

5...?aire-1h1ade or the same zprovided which aresuperposedon the pattern 15. ulilhzi'eesuchilaminations 1-7, l8; l9 are 'usedwhich rternxandimaybe of equal size.

Reinforcements are also applied to the anterior :rpor-tion of the device. The "reinforcement #24 iextendsl to the :front line of the la'st lamination I9 as shown-in Fig. 8. 'llhesecondreinforcement 25, being smaller, fits over and within the margin e-,';- the thirrl r einforcement 26 fits hover and-within the 'se'con'd and the fourth-reinifOFCGIDBIIt .2 is':sim-ilarly I'arran'ged.

l nnm ber'zso ".rterminedxbyz .1 the corrective (device constructed'iin accordance;

I reinforcements used is de- T I 1. The :amount .ofscontractionofthe toes which correspondingly create .a depression of the. metatarsal-heads. 1. r

11:2. ;The .amount of extension of the toe whichsis corresponding'ly desired in producing the anterior I It :isimportantthat the highest point in thick- .zstabilization.

- ness .of these reinforcements shall be .directly iinrzler and across the hingeline. Thus it ispossible .ito usegseveral additional anterior reinforcements particularly broken away; 1 5

:as would .be'indic inthe'foot.

I The anterior laminations are so placed ,on the .device that they will ;create .a fulcrum which extend and lengthen the-;-contractions of the metatarsal and phalangealistructure.

. ..u'llhe reinforcements are then covered by the ated by the particular pathology tfirst -,covering,:1ayera28 ,(Fig. 8,) which extends 1 from the hingeli neito the heel, leaving exposed the portion anterior to, the hinge line. A seeond;-cover .29 is. superposed-on the layer 28..

-While :the device thus .far described is still in .thG mOlSt state,-=all margins and edgesarepressed .down or burnished smoothly. to eliminate rough and sharp edges. 1

The .device isplaced-on the model and held thereon under pressure {to dryjfor about twenty- ;four .hours rand-thereafter. ,allowed ito dry Without any pressure for about forty-eight hours and removed from the model.

During the second drying period it is placed,.

however, on the model several times for a period of one to two hours to avoid deviation or shrinkage of the material.

After being thoroughly dried, a top cover 30 of thin leather is cemented to the device and the edges are beveled with a file or rasp, or grinding wheel.

Thereafter a, cover 3| of split leather is cemented to the bottom, thus completing the foundation stabilizer, 32.

As indicated in Fig. 12 the device is inserted in a shoe and its posterior part 33 forms a cup seat for the heel while the anterior portion extends to and under the web of the toes. The hinge line is shown in Fig. 10 is slightly exaggerated.

The modification shown in Fig. 11 differs from the previously described embodiment, therein, that the device generally designated by 34 has an integral body portion 35 instead of being laminated and provides the hinge axis and the cup shaped seat 36 identically as previously described.

The orthopedic. device herein described is in strumental in guiding, steering, balancing and stabilizing the foot in all its functional activities, and creates for the foot a normal environmental factor which by reason of its re-generated normal function strengthens and develops weakened and deformed foot structures.

While the drawings show two embodiments of material as the basic pattheinvention variouschanges may. be made with outdeparting from the purview of the invention,

nor is the method of making the device limited to the sequence of steps in carrying out the method. We, therefore, include all revisions... alterations, re-arrangements and modifications which come within the scope of the invention.

as defined in the appended claims.

We claim:

1. The method of constructing an orthopedic.

appliance, comprising the steps of casting a model of the foot, drawing a line on the model connecting the firstand fifth metatarsal phalangeal joints, placing on the model a softened moist layer of fabricated cellulose acetate to cover't'he plantar surface of the model from the heel'to a point under the web portion of 'tii-toes idrawing a line on said layercoincident to the normal hinge line which is spaced anteriorly from the model line a distance equal to the deviatio n ,t l;1j eipha1; langes from their v longitudinal alignment with the metatarsal bones, placing moistened laminations on said layer extending posteriorly from said lines, and maintaining said layer and said laminations under pressure on said model until hardened to obtain rigidity of said layer from the heel to said line. i

2. The method of constructing an orthopedic appliance, comprising the steps of casting a model of the foot, placing on the model a moist layer of fabricated cellulose acetate to cover the plantar surface from the heel to and under the web portion of the toes and providing a cup seat at the heel, drawing a. line on said layer which coincides with the normal hinge line and is spaced from a line connecting the first and fifth metatarsal phalangeal joints, a distance equal to the deviation of the phalanges from the longitudinal alignment with the metatarsal bones, placing moistened laminations of predetermined length on said layer extending posteriorly from said layer line, and maintaining said layer and said laminations under pressure on said model'until hardened to obtain rigidity of said layer from the-heel to said line. p

3. -.The method of constructing .an orthopedic appliance comprising the steps of casting a model i of the foot, placing on the model a layer of material to cover the plantar surface from the heel to and under, the web portion of the toes and provide a cup seat at the heel, drawing a line on said layer connecting the firstand'fifth-metatarsal phalangeal joints, placing moistened laminations of predetermined length on said layer extending posteriorly from said line, placing a plurality of laminations in superposed relation :on the anterior .portion of the layer with the thickest part thereof in vertical registry with said linesandmaintaining said layer and said laminations under pressure on said model until compacted to obtain rigidity of said layer from the heelto said line.

. LOUIS DIAMOND.

MAURICE R. UDELL.

REFERENCES CITED The following references are of record in the file of this patent:

I UNITED STATES PATENTS Number 700,265 Germany Dec. 1'1, 1940 

